| NPI | 1659367621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R22485) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R109779-5) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2011-10-28 |