| NPI | 1700258589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009554) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3009554) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2021-01-14 |