NPI | 1366624033 |
---|---|
Former Name | JEANNINE S WALLNUTT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 47230) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 50354) |
Enumeration Date | 2007-12-04 |
Last Update Date | 2021-05-21 |