| NPI | 1912975004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1515) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1064155) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 1515) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-08-10 |