| NPI | 1992571764 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R256872) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R256872) | 
| Enumeration Date | 2023-12-01 | 
| Last Update Date | 2023-12-01 |