| NPI | 1679844070 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704211246) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704211246) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2014-11-10 |