| NPI | 1790150761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009681) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN86736-FNP-BC) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2015-12-02 |