| NPI | 1770806796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2005001915) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2005001915) |
| 163W00000X Registered Nurse (Licence: KS 1393651041) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 5375048041) | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2010-03-04 |