| NPI | 1073966099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7117) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 1534588) |
| 363L00000X Nurse Practitioner (Licence: WI 224443) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN CNP4641) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2020-10-27 |