| NPI | 1679934012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4442) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 6896-33) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN CNP 4442) | |
| Enumeration Date | 2016-03-13 |
| Last Update Date | 2022-04-18 |