| NPI | 1083056642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R116591-5) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK 110671) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2016-09-14 |