| NPI | 1811667124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: FL 11015451) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11015451) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-11-23 |