| NPI | 1255317160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A154471) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 2723) |
| 363L00000X Nurse Practitioner (Licence: MN R143364-7) | |
| 363L00000X Nurse Practitioner (Licence: IA 108760) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2021-04-13 |