| NPI | 1639832975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-80258-061) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 53-80258-061) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2022-02-11 |