| NPI | 1447723796 |
|---|---|
| Former Name | BLAKE KATHLEEN WINCENTSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 8198) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: IL 209018598) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2021-05-26 |