| NPI | 1043615560 |
|---|---|
| Former Name | JENNIFER DIANE PSOTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 6088-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 171464-30) |
| 363L00000X Nurse Practitioner (Licence: WI 6088-33) | |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2023-07-31 |