| NPI | 1912070905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001482) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health (Licence: IA 1482) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2021-11-12 |