| NPI | 1962858100 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN CNP 4685) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MN R 188429-6) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2016-07-22 |