| NPI | 1972816205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1193) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 160384-6) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2020-08-07 |