NPI | 1740739200 |
---|---|
Former Name | ANDREA KATE DYKSTRA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-127051) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704275965) |
Enumeration Date | 2016-09-26 |
Last Update Date | 2025-04-09 |