| NPI | 1659850501 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9406046) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 9406046) | 
| Enumeration Date | 2018-08-11 | 
| Last Update Date | 2021-07-15 |