| NPI | 1154372050 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R0793333) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R0793333) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MN R0793333) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2011-10-04 |