| NPI | 1689300105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: ID 55197) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: HI 14890) |
| 164W00000X Licensed Practical Nurse (Licence: OR 202206783LPN) | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-07-27 |