| NPI | 1790105567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 234142) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024171479) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-08-19 |