| NPI | 1679768980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024167239) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001195461) |
| 363L00000X Nurse Practitioner (Licence: VA 0024167239) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2007-09-10 |