| NPI | 1114217163 |
|---|---|
| Former Name | JESSICA LAUREN GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME110651) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME110651) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2019-09-20 |