| NPI | 1255830774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 5748) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 171947-1) |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2018-08-03 |