| NPI | 1770353633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 4038625) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 117625) |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2025-06-09 |