| NPI | 1154763837 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 1010) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 1010) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R191210-0) | |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2022-08-25 |