| NPI | 1699077420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 2042) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 2042) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 2042) | |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2014-04-17 |