| NPI | 1205917275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 93192) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 109788-9) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-27 |