| NPI | 1245579267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 3682) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 2249607) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4905) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN CNP 3682) | |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2020-09-28 |