| NPI | 1114456456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 5315) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 218186-2) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2019-10-17 |