| NPI | 1720042542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KY 3000960) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1042113) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3000960) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2015-11-09 |