| NPI | 1902179286 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5006333) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209008596) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209008596) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5006333) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2020-10-08 |