| NPI | 1750489126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005401) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 53690) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: WV 53690) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-11-02 |