| NPI | 1790505873 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OR 10032067) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 10032067) |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2025-03-18 |