| NPI | 1215480405 |
|---|---|
| Former Name | JENNIFER E GUSTUM ( OR) CANDLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7044) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 7044) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2022-08-15 |