| NPI | 1649535857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704289346) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 841542) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 26848) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2022-07-01 |