| NPI | 1235170259 |
|---|---|
| Former Name | JESSICA AMANDA MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AL 1-080516) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1-080516) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2008-07-16 |