| NPI | 1982905600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 61189) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75265-011) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2020-01-22 |