| NPI | 1982752580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: VA 0024179598) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024179598) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2025-01-15 |