| NPI | 1790293116 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-146098) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-146098) |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2022-03-17 |