| NPI | 1790255446 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209-023294) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2018015023) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2026-08-05 |