| NPI | 1043695380 |
|---|---|
| Former Name | MICHELLE WISTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP3940) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN CNP3940) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2020-08-07 |