| NPI | 1780128983 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN227890) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 258497) |
| 363LF0000X Nurse Practitioner Family (Licence: NC 5011825) | |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2020-07-08 |