| NPI | 1386925410 |
|---|---|
| Former Name | MINI MARY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704223519) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704223519) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704223519) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2021-03-01 |