| NPI | 1770832966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704245159) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704245159) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2019-02-12 |