| NPI | 1114100260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1639) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 1639) |
| 363L00000X Nurse Practitioner (Licence: MN R159940-0) | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2020-10-05 |