| NPI | 1326339938 |
|---|---|
| Former Name | JENNIFER SUSAN PROG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704144751) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704144751) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2024-03-08 |