| NPI | 1639552896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 6719) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 20035) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 073181-23) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2018-05-09 |