| NPI | 1790184398 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN R 118153-3) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 179196-30) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2014-08-19 |