| NPI | 1679816870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 22494) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 005324) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 005324) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R203517) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5010395) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2022-03-01 |