| NPI | 1104012145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 104299142) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: MN R 103753-5) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2021-04-05 |