| NPI | 1093107583 |
|---|---|
| Former Name | JEANA MARIE CHURCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-02204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 81740) |
| 207Q00000X Family Medicine (Licence: WV 3208) | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2026-01-07 |