| NPI | 1972792968 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2017028435) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2003005268) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2010037934) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2022-04-14 |