| NPI | 1770393241 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: IA P1970) |
| Additional Taxonomies | 261QV0200X Clinic/Center, VA (Licence: IA P19170) |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-09-16 |