| NPI | 1912597824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704310343) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 20328075423) |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2021-10-24 |