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 |