| NPI | 1912419623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 20484.1792) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 20484) |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 1792) | |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2021-01-08 |