| NPI | 1811150063 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 5569)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 173341)  | 
| 363LF0000X Nurse Practitioner, Family (Licence: TX 876)  | |
| Enumeration Date | 2008-07-08 | 
| Last Update Date | 2018-03-17 |