| NPI | 1912069121 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5004071)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN117749NP)  | 
| Enumeration Date | 2006-12-14 | 
| Last Update Date | 2021-04-01 |