| NPI | 1912486887 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 3012495) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3012495) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: KY 3012495) | |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2019-05-01 |