| NPI | 1164966123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN CNP 5015) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R222209-3) |
| 363L00000X Nurse Practitioner (Licence: MN CNP 5015) | |
| Enumeration Date | 2016-12-10 |
| Last Update Date | 2017-03-21 |