| NPI | 1912420563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345732) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 720412-1) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2020-11-03 |