| NPI | 1699750208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3000480) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 480-P) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 480P) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2018-03-30 |