| NPI | 1720619901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704335207) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704335207) |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2021-06-07 |