| NPI | 1821509936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000805) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN229872) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 5490) | |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2019-10-14 |