| NPI | 1396682647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 14031) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 18133-33) |
| Enumeration Date | 2026-05-04 |
| Last Update Date | 2026-08-25 |