| NPI | 1417677675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10055) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704349118) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2023-04-05 |