| NPI | 1881400711 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 4782619-4405) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 4782619-8900) | 
| Enumeration Date | 2024-12-05 | 
| Last Update Date | 2024-12-05 |