| NPI | 1811095193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 730) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R139034-0) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 730) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-07 |