| 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 |