NPI | 1780058453 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11012415) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5009055) |
363L00000X Nurse Practitioner (Licence: FL 0116420) | |
Enumeration Date | 2015-11-18 |
Last Update Date | 2023-09-06 |