| NPI | 1871062349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WY MT5055050) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 41951.1832) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2019-05-14 |