| NPI | 1972147759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11004614) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11004614) |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2023-02-09 |