| NPI | 1174802151 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1732) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1734566) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2020-08-10 |