| NPI | 1982105516 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL F308651-1)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 682-972)  | 
| Enumeration Date | 2018-02-28 | 
| Last Update Date | 2019-07-10 |