| NPI | 1750384566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003586) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 6122) |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3003586) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2018-12-17 |