| NPI | 1417952805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1196) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 145873-2) |
| 363L00000X Nurse Practitioner (Licence: WI 1712) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2020-10-06 |