| NPI | 1952388506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 2007007336) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 360951-22) |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2015-11-10 |