| NPI | 1205878592 |
|---|---|
| Former Name | JAN DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: TX 588314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 588314) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2013-08-26 |