| NPI | 1699174854 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: TX AP126402) | 
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: CA 95019569) | 
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2014-08-13 | 
| Last Update Date | 2025-10-01 |