| NPI | 1790186062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 221768-4) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 221768-4) |
| 163W00000X Registered Nurse (Licence: MA RN2288546) | |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2017-01-24 |