| NPI | 1982070553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: SC 19690) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: SC 19690) |
| 363LF0000X Nurse Practitioner Family (Licence: CA 95013079) | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2024-03-25 |