| NPI | 1972772317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 120564) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 117415) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 6298P) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2015-08-12 |