| NPI | 1760779706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1492) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 173776-7) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2020-08-07 |