| NPI | 1972841112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5171) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209-009863) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2020-08-10 |