| NPI | 1689334880 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A166135) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: IA 118004) |
| 163WP0200X Registered Nurse Pediatrics (Licence: IA 118004) | |
| 363LC1500X Nurse Practitioner Community Health (Licence: IA A166135) | |
| 363LF0000X Nurse Practitioner Family (Licence: IA A166135) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: IA A166135) | |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2022-02-23 |