| NPI | 1104129568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R 180285-4) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP 0020) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN R1802854) | |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2020-08-07 |