| NPI | 1639811961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 9201) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 1959464) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 9201) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2022-06-06 |