| NPI | 1720195639 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 323-033) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 93432-030) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |