| NPI | 1659624138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704149241) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 15347) |
| 364S00000X Clinical Nurse Specialist (Licence: CA 2258) | |
| Enumeration Date | 2012-10-20 |
| Last Update Date | 2012-10-20 |