| NPI | 1912048133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71005528A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0514) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2015-06-19 |