| NPI | 1790303006 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5013330) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-08-04 |