| NPI | 1760292452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704318207) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704318207) |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2025-09-05 |