| NPI | 1730799834 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 885670)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 904062)  | 
| Enumeration Date | 2020-08-04 | 
| Last Update Date | 2024-09-15 |