| NPI | 1164855532 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2510) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MN R 146772-3) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2020-09-22 |