| NPI | 1700252798 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1153984) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28202837A) |
| 163W00000X Registered Nurse (Licence: NM RN-79297) | |
| 163WE0003X Registered Nurse, Emergency (Licence: WA RN60454041) | |
| 163W00000X Registered Nurse (Licence: NV TRN339829) | |
| 163W00000X Registered Nurse (Licence: TX 865893) | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2025-02-13 |