| NPI | 1083870646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R 203612-4) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 002467916) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 792) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2019-03-19 |