| NPI | 1720689862 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024180390) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024180390) | 
| Enumeration Date | 2020-11-05 | 
| Last Update Date | 2022-03-23 |