| NPI | 1669209052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN288325) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: GA RN288325) |
| 261QH0100X Clinic/Center Health Service (Licence: GA RN288325) | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: GA RN288325) | |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |