| NPI | 1740833110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004016) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN252744) |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2021-10-21 |