| NPI | 1912689027 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2324593)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2324593)  | 
| Enumeration Date | 2023-08-07 | 
| Last Update Date | 2023-10-27 |