| NPI | 1710267539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2012039527) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 2012039527) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2017-03-31 |