NPI | 1063990273 |
---|---|
Former Name | JAYLA BREANN MIDDLETON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.030975) |
Enumeration Date | 2018-07-31 |
Last Update Date | 2025-04-10 |