| NPI | 1780109868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60796718) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN60796717) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704205199) | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2021-03-22 |