| NPI | 1700154374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 75590) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2012036926) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2013-05-10 |