| NPI | 1790100121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA A162932) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 18384) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2021-08-17 |