| NPI | 1649596982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.002361) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QU0200X Clinic/Center, Urgent Care | |
| 363L00000X Nurse Practitioner (Licence: IL 277.002361) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209007994) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71004747A) | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2023-11-09 |