| NPI | 1346793940 |
|---|---|
| Former Name | JENNA KRISTINE FANKHAUSER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6994455-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 6994455-8900) |
| Enumeration Date | 2016-07-31 |
| Last Update Date | 2016-10-18 |