| NPI | 1770985012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003643) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 04/30/201) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2016-05-06 |