| NPI | 1336687912 |
|---|---|
| Former Name | JESSICA WALDREN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017002826) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011019534) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77515-122) | |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2018-12-27 |