NPI | 1134264153 |
---|---|
Former Name | JESSICA MIRACLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN03651) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP128065) |
Enumeration Date | 2007-02-20 |
Last Update Date | 2023-08-07 |