| NPI | 1962547711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2001023101) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 53-45977-122) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2012-05-14 |