| NPI | 1700051703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3011524) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 17562) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN164980) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2018-03-01 |