| NPI | 1972139566 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN184678)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 184678)  | 
| Enumeration Date | 2020-03-16 | 
| Last Update Date | 2024-10-03 |