NPI | 1255807087 |
---|---|
Former Name | JACLYN BLAIR LUCCHESE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: OR 10003878) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 22326) |
Enumeration Date | 2018-10-19 |
Last Update Date | 2023-03-10 |