| NPI | 1861970642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209017762) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.017762) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2023-09-13 |