| NPI | 1649259391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 3455) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R-136838-5) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2020-08-07 |