| NPI | 1649338856 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN146690) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R45240) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN CNP5610) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-02-28 |