| NPI | 1790121549 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IN 71004499A) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: IN 71004499A) |
| 363L00000X Nurse Practitioner (Licence: IN 28113039A) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2019-09-13 |