| NPI | 1619918406 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN R092298-4) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R092298-4) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2011-04-29 |