| NPI | 1811496003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2018005316) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012022949) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2018005316) | |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2021-03-09 |