| NPI | 1194144063 |
|---|---|
| Former Name | JORDAN ALYSSA ANN ENNS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2018-00680) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX BP10049683) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2019-01-09 |