| NPI | 1790979300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN52805-FNP-BC) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 52805) |
| 363L00000X Nurse Practitioner (Licence: WV 52805) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2015-12-08 |