NPI | 1245600121 |
---|---|
Former Name | JILLIAN BLAIR KAWALEK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.18122) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.359991-1) |
Enumeration Date | 2015-10-05 |
Last Update Date | 2018-02-20 |