| NPI | 1689212409 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.020599) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 209.020599) |
| 363L00000X Nurse Practitioner (Licence: IL 209.020599) | |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2023-09-20 |