| NPI | 1790061091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024171185) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F336761) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9316522) | |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2022-03-03 |