| NPI | 1649734864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 6774) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2141970) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-12-11 |