| NPI | 1639629504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010608) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77423-042) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2018-08-06 |