| NPI | 1962155903 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 10454) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 10454) |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2022-03-30 |