| NPI | 1962400150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CT 001512) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 001512) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2019-01-25 |