| NPI | 1649290529 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1617) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 2494-033) |
| 363L00000X Nurse Practitioner (Licence: MN R131683-2) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R 131683-2) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-07 |