| NPI | 1639880404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 1174710) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28210276A) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2022-12-12 |