| NPI | 1720279110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WV AP30007678) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OR 200750022NP PNP-PP) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2023-03-29 |