| NPI | 1770760118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60191014) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID PA1691) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2018-12-17 |