| NPI | 1710958590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 083330) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MO 083330) |
| 363LF0000X Nurse Practitioner Family (Licence: KS 44725) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-03-07 |