| NPI | 1033577762 |
|---|---|
| Former Name | JENNA RUTH PETERSDORF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367A00000X Advanced Practice Midwife (Licence: IL 209.013259) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife (Licence: WI 149030-32) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2023-06-26 |