| NPI | 1710511142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2020005214) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 53-79173-041) |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-02-25 |