| NPI | 1790197853 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5007068) | 
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F381546-1) | 
| Enumeration Date | 2014-05-23 | 
| Last Update Date | 2015-03-16 |