| NPI | 1689046989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA MA057848) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2018-01-17 |