| NPI | 1760768774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: MI 4704179301) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704179301) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-12-04 |