| NPI | 1871579177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2614) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R132921-4) |
| 363L00000X Nurse Practitioner (Licence: IA 071415) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2024-02-09 |