| NPI | 1215968177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP0187) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R116803-5) |
| 363L00000X Nurse Practitioner (Licence: ND R26025) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2018-04-04 |