| NPI | 1861109555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 10014088) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61683297) |
| 363L00000X Nurse Practitioner (Licence: FL 11022905) | |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2026-08-18 |