| NPI | 1316426091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 11396) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8562) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 8562-33) | |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2024-08-26 |