| NPI | 1871194563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 221957) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 27884) | |
| Enumeration Date | 2020-11-08 |
| Last Update Date | 2024-05-06 |