| NPI | 1790303568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2302172) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MA RN2302172) |
| 163W00000X Registered Nurse (Licence: MA 2302172) | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2021-12-16 |