| NPI | 1861963563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000490) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL APRN11000490) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL 11000490) | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2020-03-24 |