| NPI | 1750036067 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021046263)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 5380542)  | 
| Enumeration Date | 2022-02-15 | 
| Last Update Date | 2022-04-26 |