| NPI | 1639509557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1102) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1735141) |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2020-10-06 |