| NPI | 1700158342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1107A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60262024) |
| Enumeration Date | 2012-01-28 |
| Last Update Date | 2012-01-28 |