NPI | 1194297879 |
---|---|
Former Name | JESSICA TALLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209018330) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209018330) |
Enumeration Date | 2018-12-19 |
Last Update Date | 2021-09-16 |