| NPI | 1861017972 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001239797) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-08-11 |