| NPI | 1790654796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 31362) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 2025071997) |
| Enumeration Date | 2025-10-30 |
| Last Update Date | 2026-03-02 |