| NPI | 1639613623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: IL 209.015260) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: IL 209.015260) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: IL 209.015260) | |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2016-12-09 |