| NPI | 1912383647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4060) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP 4060) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2020-08-10 |