| NPI | 1780883256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R1287246) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 0589) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2020-01-09 |