| NPI | 1902372600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP6237) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 9641-33) |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2021-12-20 |