| NPI | 1639700560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MO 2019041583) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: MO 2013003356) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: IL 209.020381041.465207) | |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2022-09-14 |