| NPI | 1821075979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: AZ AP1804) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: CA 18860) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: WA AP30007059) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2020-11-04 |