| NPI | 1710508759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704307868) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704307868) |
| 163W00000X Registered Nurse (Licence: MI 4704307868) | |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2023-01-25 |