| NPI | 1790487577 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 27199) | 
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5021189) | 
| Enumeration Date | 2023-03-17 | 
| Last Update Date | 2025-10-28 |