| NPI | 1790400992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 72977) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN00124469) |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2022-10-10 |