NPI | 1316175276 |
---|---|
Former Name | JENNA JACQUELINE WIRTZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A12863) |
Additional Taxonomies | 208000000X Pediatrics (Licence: WA OP 60356123) |
208000000X Pediatrics (Licence: AZ 52022) | |
208M00000X Hospitalist (Licence: AZ 005879) | |
Enumeration Date | 2009-06-30 |
Last Update Date | 2020-07-01 |