| NPI | 1639620610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.146408.MEDS-IV) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |