| NPI | 1679219588 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 905326) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 905326) | 
| Enumeration Date | 2022-05-12 | 
| Last Update Date | 2025-03-20 |