| NPI | 1366992356 |
|---|---|
| Former Name | JACLYN MICHELLE DICKMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1164664) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0017143446) |
| 163W00000X Registered Nurse (Licence: VA 0001237651) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024174217) | |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2025-01-13 |