| NPI | 1770199770 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11009109)  | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11009109)  | 
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11009109)  | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11009109)  | |
| Enumeration Date | 2020-09-16 | 
| Last Update Date | 2020-09-16 |