| NPI | 1902431166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 10790) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 7268) |
| 363L00000X Nurse Practitioner (Licence: WI 10790) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2024-01-23 |