| NPI | 1912520800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 105691) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP021993) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2022-09-15 |