| NPI | 1760780928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704218860) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704218860) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 282820) | |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2016-02-10 |