| NPI | 1972151496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MI 4704322643) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: MA RN2337622) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2023-01-03 |