| NPI | 1639820830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1049188) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 1049188) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX 1049188) | |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2022-01-10 |