| NPI | 1790068732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 75499) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2011034272) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2018-04-05 |