| NPI | 1770831067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 6840) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 05082) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F340561-1) | |
| Enumeration Date | 2012-08-17 |
| Last Update Date | 2019-10-17 |