| NPI | 1790309110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 4938420-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 4938420-3102) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 4938420-4405) | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2022-04-22 |