| NPI | 1891316055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704364840) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11001587) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2021-03-29 |