| NPI | 1639160682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R863588) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 11698) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2007-07-18 |