| NPI | 1114610102 |
|---|---|
| Former Name | JESSICA LORINNE HANSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001200-15) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2023-07-07 |