| NPI | 1831176742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1008) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R343200-22) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 1008) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-08-10 |