| NPI | 1760043392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12.008180) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 10.158838) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2019-06-25 |