| NPI | 1811264104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2021026634) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 735706) |
| 363L00000X Nurse Practitioner (Licence: MO 104056) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 104056) | |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2021-11-15 |