| NPI | 1760474803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 4403-33) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 2636122) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2012-03-15 |