| NPI | 1568963866 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 8995) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS LIDD-8T8QP1) |
| 363L00000X Nurse Practitioner (Licence: LA 200056) | |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2022-02-14 |