| NPI | 1104358092 |
|---|---|
| Former Name | JESSICA R SAMUELS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2014011742) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-119873-072) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2017-11-03 |