| NPI | 1770568735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 378) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 134378-2) |
| 363L00000X Nurse Practitioner (Licence: MN R134378-2) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2020-08-07 |