| NPI | 1174937114 |
|---|---|
| Former Name | JESSICA LYN DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 5804) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: CT 94495) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2018-09-10 |