| NPI | 1821653643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: KY 2032077) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2026-09-02 |