| NPI | 1962923292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN309279) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 7617) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 7617) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-20 |