| NPI | 1639780760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024193422) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 0995769-NP) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2026-05-12 |