| NPI | 1720383763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 80) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA RN622174) |
| 363L00000X Nurse Practitioner (Licence: MN R176035-2) | |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2021-05-27 |