| NPI | 1790733624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 200612) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WY 56244) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11014597) | |
| 363L00000X Nurse Practitioner (Licence: UT 14191416-4405) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2025-07-16 |