| NPI | 1790857365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704215161) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704215161) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704215161) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2016-10-10 |