NPI | 1063891554 |
---|---|
Former Name | JENNA LYNN TJOSSEM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO DR.0059813) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0005530) |
Enumeration Date | 2015-05-29 |
Last Update Date | 2021-04-07 |