| NPI | 1952416786 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 2148) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 2148) | 
| 363LF0000X Nurse Practitioner, Family (Licence: MN R128980-4) | |
| Enumeration Date | 2006-08-20 | 
| Last Update Date | 2020-11-04 |