| NPI | 1912312604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2724) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1856062) |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2020-08-10 |