| NPI | 1104022573 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 157580-30) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R 164377-0) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 157580-30) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2021-08-10 |