| NPI | 1972945673 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 201243) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC F0713047) | 
| Enumeration Date | 2013-07-23 | 
| Last Update Date | 2016-12-05 |