| NPI | 1649612169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704305348) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH COA.14838-NP) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2015-04-14 |