| NPI | 1225274632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 2058) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 2058) |
| 363L00000X Nurse Practitioner (Licence: MN 2058) | |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2020-08-06 |