| NPI | 1821112525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN191241) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 55866) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-01-29 |