| NPI | 1780015115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5374) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G104350) |
| 363L00000X Nurse Practitioner (Licence: MN CNP5374) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2020-08-07 |