| NPI | 1700882792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WY 21836.1074) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 82977) |
| 363LF0000X Nurse Practitioner, Family (Licence: NE 40468) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2017-04-25 |