| NPI | 1366816753 |
|---|---|
| Former Name | JENNIE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60546515) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MD-18403) |
| 208000000X Pediatrics (Licence: NC 32579) | |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2018-06-15 |