| NPI | 1639161722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024170320) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 6685) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 6685) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024170320) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-01-10 |