| 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 |