| NPI | 1770550204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 783) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R129784-1) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2022-08-22 |