| NPI | 1710063904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NE 110165) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA10405NP) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2013-09-17 |