| NPI | 1962946509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP 4914) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 4914) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2022-09-26 |