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 |