| NPI | 1972004422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277001281) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.017012) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2024-04-21 |