| NPI | 1639619794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: TX 28450) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 324574) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2020-06-03 |