| NPI | 1710091459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 975) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA 129146) |
| 363L00000X Nurse Practitioner (Licence: MN R204376-4) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH NP19351) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-09-28 |