| NPI | 1790596344 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704339406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704339406) |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2026-01-09 |