| NPI | 1821676651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 9674) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.008089) |
| 363A00000X Physician Assistant (Licence: AZ 9674) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-07-15 |