| NPI | 1043917297 |
|---|---|
| Former Name | JACLYN NICOLE BOTTERBUSH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 33639) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: TN 199030) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2023-04-18 |