| NPI | 1700874096 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN177502) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 177502) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN177502) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2023-04-25 |