| NPI | 1144565656 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R 213100-3) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041388727) |
| 363L00000X Nurse Practitioner (Licence: MN 0102) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209009718) | |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2020-10-05 |