| NPI | 1982792107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 110548) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A100363) |
| 363LF0000X Nurse Practitioner Family (Licence: NE 110548) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2017-12-11 |