| NPI | 1972040855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009233) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 5009233) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2023-12-19 |