| NPI | 1629838297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 11472) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 15175) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 15175-33) | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-06-03 |