NPI | 1073826764 |
---|---|
Former Name | JACLYN THERESA MCBRIDE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0999203) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 194930) |
Enumeration Date | 2010-07-22 |
Last Update Date | 2023-10-06 |