| NPI | 1861029688 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 11137172-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 11137172-8900) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2021-10-16 |