| NPI | 1679962112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209026766) |
| Additional Taxonomies | 163WM0705X Registered Nurse Medical-Surgical (Licence: IL 041-272832) |
| 163WP2201X Registered Nurse Ambulatory Care (Licence: IL 041-272832) | |
| 163WR0006X Registered Nurse Registered Nurse First Assistant (Licence: IL 041-272832) | |
| 163WX0800X Registered Nurse Orthopedic (Licence: IL 041-272832) | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2023-03-13 |