| NPI | 1710376405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN38180NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP014237) |
| Enumeration Date | 2015-01-18 |
| Last Update Date | 2015-03-16 |