| NPI | 1508875063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP1484) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 142515-0) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-08-31 |