| NPI | 1871069104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP019345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN650706) |
| 363LF0000X Nurse Practitioner Family (Licence: PA SP019345) | |
| Enumeration Date | 2018-10-14 |
| Last Update Date | 2021-04-29 |