| NPI | 1174833610 |
|---|---|
| Former Name | JENNIFER BETH BLACKFOX |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2017036707) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN592636) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP010917) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2022-05-17 |