| NPI | 1245483528 |
|---|---|
| Former Name | JESSICA ANN STAFFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 6678-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 148743-30) |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2021-01-11 |