| NPI | 1104804582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN R158703-0) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ND R26277) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN R158703-0) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP125504) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2019-07-18 |