| NPI | 1790107381 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN229849) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: GA PCH007502) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2021-06-11 |