| NPI | 1972055572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MO AG1016149) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: MO AG1016149) |
| Enumeration Date | 2016-10-30 |
| Last Update Date | 2016-10-30 |