| NPI | 1104486661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 11340) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012378) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-07-30 |