| NPI | 1972124642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704306321) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704306321) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2020-08-27 |