| NPI | 1710232863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 75) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 172141-4) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2020-10-06 |