| NPI | 1013387950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4873) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP 4873) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2015034703) | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2020-08-07 |