| NPI | 1720052350 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 3223) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 175233-1) |
| 363L00000X Nurse Practitioner (Licence: IL 209000613) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 175233-1) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2019-04-29 |