| NPI | 1629264668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP4999) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 3174-033) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2020-01-13 |