| NPI | 1770916546 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0001211426) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024171102) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2014-04-09 |