| NPI | 1699412353 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10032057)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F349358)  | 
| Enumeration Date | 2022-05-15 | 
| Last Update Date | 2025-09-29 |