| NPI | 1912504648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: TX 1016146) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: TX 1016146) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX 1016146) | |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2021-07-19 |