| NPI | 1770072795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 68340) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3015490) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 6125) | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2022-07-12 |