| NPI | 1790093391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 201050177NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201020177NP) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2015-10-13 |