| NPI | 1629553300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 6109) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A152724) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A152724) | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2020-09-18 |