| NPI | 1831171578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11005045) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 1909) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 001909) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2021-10-01 |