| NPI | 1932863636 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 111318) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 111318) | 
| Enumeration Date | 2021-10-28 | 
| Last Update Date | 2021-10-28 |