| NPI | 1962711739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1509) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R-161461-5) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2020-08-10 |