| NPI | 1053398669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2297) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R-1003970) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 2297) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2019-01-17 |