| NPI | 1871969105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209013047) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015026485) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209013047) | |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2018-01-11 |