| 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 |