| NPI | 1962069658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 7590) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2059295) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2020-12-21 |