| NPI | 1679387054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 12484) |
| Additional Taxonomies | 208VP0000X (Licence: MN 12484) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 12484) | |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-04-27 |