| NPI | 1700219789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 76396) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013029344) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2015-10-08 |