| NPI | 1770571861 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024185730)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 21721)  | 
| Enumeration Date | 2005-10-12 | 
| Last Update Date | 2022-11-17 |