| NPI | 1790255248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704267746) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704267746) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2024-08-30 |