| NPI | 1285095398 |
|---|---|
| Former Name | JENNIFER SHANNON RAYWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201707705NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024172937) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024172937) | |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2021-01-14 |