| NPI | 1780090852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2014013825) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-76288-022) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2014-07-09 |