| NPI | 1760762017 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 39585) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA UP005532B) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2011-08-18 |