| NPI | 1700400512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 113214) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 2126) |
| 363LF0000X Nurse Practitioner, Family (Licence: NE 113214) | |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2021-09-17 |