NPI | 1134424104 |
---|---|
Former Name | JENNIFER STAFSLIEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4336) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 4336-33) |
363LF0000X Nurse Practitioner, Family (Licence: IA 126937) | |
Enumeration Date | 2011-01-21 |
Last Update Date | 2024-11-11 |