| NPI | 1962830026 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN R-160051-9) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 1821) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2024-02-14 |