| NPI | 1881047603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4654) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP4654) |
| 363L00000X Nurse Practitioner (Licence: MN 1368152) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN CNP 4654) | |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2020-09-28 |