| NPI | 1801125968 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704281760) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 14635) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704281760) | |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2015-11-27 |