NPI | 1043688161 |
---|---|
Former Name | JENINE ROBERTS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002533) |
Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA NP95002533) |
Enumeration Date | 2015-09-04 |
Last Update Date | 2024-04-11 |