| NPI | 1962114215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11031536) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.026400) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2025-12-11 |