| NPI | 1780080309 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA-16595-NP) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN253977-COA1) | 
| Enumeration Date | 2014-11-10 | 
| Last Update Date | 2014-11-19 |