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Registrant NPI Number: 1073968715

Individual Registrant:
Gender: F
Sole Proprietor

Location and contact information for practice:
21403 SE 70TH AVE  HAWTHORNE, FL 32640 US
Tel: 412-477-9382  Fax: --

Contact information for business:
701 SW 62ND BLVD APT 90  GAINESVILLE, FL 32607-2078 US
Tel: 412-477-9382  Fax: --

Registration Information:
NPI: 1073968715
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y174400000XOther Service Providers

Legacy codes, insurance codes and state license numbers:



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