| NPI | 1538134630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1085) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R090450-4) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 1085) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-04-28 |