| NPI | 1700139359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2011022110) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2006003044) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-10-19 |