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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1245632819
- **Gender:** F
- **Credential:** MSN, RN, ACCNS-AG, C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 364S00000X | Clinical Nurse Specialist | 2013042563 | MO | — |
| 364SA2200X | Adult Health Clinical Nurse Specialist | 2013042563 | MO | Yes |

## Other

- **Enumeration date:** 09/25/2014
- **Last updated:** 05/20/2019