| NPI | 1124628557 |
|---|---|
| Former Name | JESSICA WIETHOLTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1017806) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031212) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2022-06-23 |