| NPI | 1962729657 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 06072)  | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP06072)  | 
| Enumeration Date | 2010-04-21 | 
| Last Update Date | 2019-01-18 |