| NPI | 1376099424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R39903) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-104610) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: ND R39903) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT 104610) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2019-08-05 |