| NPI | 1912995796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 546) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MN 131221-01) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2007-07-08 |