| NPI | 1780220533 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 113033) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 113033) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A157050) | |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2020-01-29 |