| NPI | 1639479306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 16280.1063) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA 1218) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2012-06-25 |