| 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 |