| NPI | 1790174522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015001139) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011005298) |
| 163W00000X Registered Nurse (Licence: KS 13-107895-072) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2017-03-28 |