| NPI | 1790260602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.017878) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209017) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2022-09-07 |