| NPI | 1962804641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201503486NP-PP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: ID NP-1503A) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2018-07-24 |