| NPI | 1700458254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MO 2012032038) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IL 043125358) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |