| NPI | 1013077304 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP 0382) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R204163-0) | 
| Enumeration Date | 2006-12-09 | 
| Last Update Date | 2025-09-12 |