| NPI | 1659619765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024182143) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95008253) |
| 363L00000X Nurse Practitioner (Licence: GA RN152000) | |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2021-08-18 |