| NPI | 1063414084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R155546-0) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ND R28369) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2012-09-13 |