| NPI | 1043374986 |
|---|---|
| Former Name | NICOLE JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NY 248629) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 249629) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2019-01-17 |