| NPI | 1407860273 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1099) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R147127-2) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 1099) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-08-10 |