| NPI | 1962975698 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704275310) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MI 4704275310) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2019-01-28 |