| NPI | 1700309796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5240) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP5240) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 12201) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 5240) | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2024-07-30 |