| NPI | 1255407284 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R1459582) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1459582) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MN R1459582) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-06-27 |