| NPI | 1942734314 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 007267) |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2018-07-04 |