| NPI | 1750758645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN CNP 4057) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 6583-33) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2021-03-04 |