| NPI | 1679164040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC AG11190064) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5013309) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2021-01-28 |