| NPI | 1972082170 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3014119) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 24514) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2020-02-19 |