| NPI | 1740275189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2007018124) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2007018124) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 9316) | |
| 363AM0700X Physician Assistant, Medical (Licence: MO 2007018124) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2023-09-20 |