| NPI | 1972181576 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN275306)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN275306)  | 
| Enumeration Date | 2021-04-01 | 
| Last Update Date | 2022-11-22 |