| NPI | 1912453606 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 006705) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 006705) | 
| Enumeration Date | 2016-09-01 | 
| Last Update Date | 2017-02-24 |