| NPI | 1689157406 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024176482) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024176482) | 
| Enumeration Date | 2018-09-07 | 
| Last Update Date | 2021-06-28 |