| NPI | 1912512849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704328121) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 06201513) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2021-03-16 |