| NPI | 1689996621 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 342923)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 577428)  | 
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307088)  | |
| Enumeration Date | 2010-02-18 | 
| Last Update Date | 2019-12-20 |