| NPI | 1639534860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 244074) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC SAND-TYPTDC) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2020-10-25 |