| NPI | 1639719230 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2020000525) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2020000525) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2020000525) | |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-03-25 |