| NPI | 1164623716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 20000337) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MN R 143878-1) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-09-11 |