| NPI | 1073764494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 11793) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 754347) |
| 363LF0000X Nurse Practitioner Family (Licence: TX AP116872) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2025-07-21 |