| NPI | 1962860684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: KS 53-77182) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-77182) |
| 363L00000X Nurse Practitioner (Licence: MO 2016003782) | |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2022-04-28 |