| NPI | 1902204969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704279343) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4704279343) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704279343) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2021-03-04 |