| NPI | 1285713396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R1465987) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1465987) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MN R1465987) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2012-09-19 |