| NPI | 1790020055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 291686) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL A0812080) |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2017-02-16 |