NPI | 1205341526 |
---|---|
Former Name | JESSICA EGANA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012165) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95012165) |
Enumeration Date | 2017-12-08 |
Last Update Date | 2022-12-05 |