| NPI | 1902511686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704345032) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704345032NSA2211G) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2023-03-14 |