| NPI | 1841500055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: MS A810518) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: TN 15361) |
| 163W00000X Registered Nurse (Licence: TN 172951) | |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2014-10-04 |