| NPI | 1790050821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R192394) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R192394) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024181379) | |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2021-06-24 |