| NPI | 1669760088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201404741) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 302521-4405) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2019-04-28 |