| NPI | 1568965200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP6412) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R2469878) |
| 363L00000X Nurse Practitioner (Licence: TN 192990) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 6412) | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2019-08-05 |