| NPI | 1639752827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041.445533) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704315087) |
| 363L00000X Nurse Practitioner (Licence: MI 4704315087) | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2021-05-04 |