| NPI | 1184045148 |
|---|---|
| Former Name | JENNIFER R WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN11019090) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 28148319A) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 71004791A) | |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2022-05-03 |