| NPI | 1760730733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: FL 9248897) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: CT 004994) |
| 363L00000X Nurse Practitioner (Licence: MA 2291334) | |
| Enumeration Date | 2012-08-26 |
| Last Update Date | 2023-10-12 |