| NPI | 1104163989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1832) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1859111) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: MN 4037) | |
| Enumeration Date | 2013-01-13 |
| Last Update Date | 2021-06-22 |