| NPI | 1043569528 |
|---|---|
| Former Name | JILL LEANNE KENNEWEG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 22248) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA 22248) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2016-09-20 |