| NPI | 1750770640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: WI 113915-30) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: WI 113915-30) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-01-14 |