| NPI | 1659569002 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT MED-APRN-LIC-128631) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 839833) |
| 363L00000X Nurse Practitioner (Licence: MI 4704252197) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2022-01-26 |