| NPI | 1790203818 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 317166-1) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 30641) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2022-07-21 |