| NPI | 1831172105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 0155) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP0194) |
| 363L00000X Nurse Practitioner (Licence: MN R 1721061) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2021-04-15 |