| NPI | 1700153913 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 19845) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024169617) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2019-07-19 |