| NPI | 1790020113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 16515) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN APN0000017103) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2025-05-12 |