| NPI | 1376747261 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 2004-33) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN R200410-1) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2019-08-14 |