| NPI | 1942933148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 7513-23) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 218791-30) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2025-05-06 |