| NPI | 1629861075 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5022406)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 30664)  | 
| Enumeration Date | 2025-05-28 | 
| Last Update Date | 2025-07-16 |