| NPI | 1750542031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 62221) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209007066) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-158251) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2021-02-05 |