| NPI | 1316660210 |
|---|---|
| Former Name | MARY ELIZABETH JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-181941) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-181941) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2024-10-19 |