| NPI | 1861944696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: LA 2203782723) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: LA 960733) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2024-03-06 |