| NPI | 1588078646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 100) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 175633-7) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2020-08-07 |