| NPI | 1659780658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1537) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 159365-5) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2020-08-07 |