| NPI | 1639171895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 1171) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 7082) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 1171) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2020-02-06 |