| NPI | 1316560865 |
|---|---|
| Former Name | RACHEL JESSICA VANDERWALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704314623) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 202008147NP) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2024-09-25 |