| NPI | 1578623831 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R158023-1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 3326) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2021-04-07 |