| NPI | 1790818250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5011581) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 5172P) |
| 363LF0000X Nurse Practitioner Family (Licence: OH RX 08595) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2021-03-26 |