| NPI | 1679630560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 111119) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA 061788) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2011-11-10 |