| NPI | 1790173250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 6228-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R230847-0) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 230847-0) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MN CNP 4242) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 135643-30) | |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2017-05-16 |