| NPI | 1336129816 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA C077838) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN R143918-8) |
| 363L00000X Nurse Practitioner (Licence: MN R143918-8) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2018-03-17 |