| NPI | 1962798793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201150064NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1068a) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-10-11 |