| NPI | 1982075701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 14228-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 247937-30) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1922-39) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2025-02-27 |