| NPI | 1912264912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN G0911005) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN A0811106) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2012-04-13 |