| NPI | 1790112993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3502P) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 300690) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2013-10-02 |