| NPI | 1740530989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OR 089005220LPN) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: OR 089005220LPN) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2012-09-14 |