| NPI | 1639787625 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 055625-23) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP201178) | 
| Enumeration Date | 2020-07-16 | 
| Last Update Date | 2021-07-23 |