| NPI | 1790751105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 45901) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT 37825) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R139228) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2022-04-14 |