| NPI | 1669860680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704310315) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA016898NP) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2020-04-23 |