| NPI | 1942712310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2017001325) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209015851) |
| 363LF0000X Nurse Practitioner Family (Licence: IL 209015851) | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2022-08-03 |