| NPI | 1083811780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 162) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 136112-0) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 162) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2020-08-07 |