| NPI | 1174502058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R34545) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R181514-2) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2011-04-01 |