| NPI | 1962257998 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 15742) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN210572) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 300916) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 101750-875) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0034749) | |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-09-09 |