| NPI | 1326691254 |
|---|---|
| Former Name | JACKIE MARIE CORVINO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 9354-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 9354-33) |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2024-05-08 |