| NPI | 1962241711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 10028288) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201042832RN) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2025-09-16 |