| NPI | 1790064731 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202102199NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2011024833) |
| 363L00000X Nurse Practitioner (Licence: KS 363LF0000X) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2021-04-14 |