| NPI | 1912028945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704096537) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA.05023-NP) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2011-08-03 |