| NPI | 1174801955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 779) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R120277-1) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2022-12-28 |