| NPI | 1760106264 |
|---|---|
| Former Name | MARIAH LYN SANDSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 9593) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 9593) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 13288) | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-12-21 |