| NPI | 1679828495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: NC 5005725) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5005725) |
| 363LF0000X Nurse Practitioner Family (Licence: NC 5005725) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2021-05-11 |