| NPI | 1962733584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 61711) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5188120) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5011004) | |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2023-10-03 |