| NPI | 1912427303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5317) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 2003157) |
| 363LF0000X Nurse Practitioner Family (Licence: MN F06171817) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2020-09-18 |