| NPI | 1629454509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4018) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP4018) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2020-08-07 |