| NPI | 1790202000 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 9296664) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: FL 9296664) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2025-11-17 |