| NPI | 1679012629 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-110409)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9337614)  | 
| Enumeration Date | 2017-02-22 | 
| Last Update Date | 2017-03-03 |