| NPI | 1639501240 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 2012009044) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 2011006924) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2021-02-18 |