| NPI | 1790068450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CT 004716) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CT 004716) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: CT 004716) | |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2023-03-07 |