| NPI | 1972580058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 2803) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R134646-2) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN R1346462) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2020-05-05 |