| NPI | 1962915397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 21108) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 107271) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2018-02-06 |