| NPI | 1790758365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA VP003931B) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F301134-1) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2011-09-16 |