| NPI | 1912568395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209.019557) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.478310) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2020-01-26 |