| NPI | 1124346879 |
|---|---|
| Former Name | JENNIFER ANN PETTIBONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 327169) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 327169) |
| 363L00000X Nurse Practitioner (Licence: OH 327169) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2015-06-26 |