| NPI | 1629213616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 3767) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 1523780) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 2008007079) | |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2020-09-29 |