| NPI | 1255313102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 3929) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R116894-1) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 75516) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2014-11-17 |