| NPI | 1811516461 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704310362) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704310362) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2020-10-09 |