| NPI | 1972907368 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704358153) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 023487) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71005146A) | |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2020-07-29 |