| NPI | 1770912172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2296) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 173774-1) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2020-08-10 |