| NPI | 1407142946 |
|---|---|
| Former Name | JESSICA RAE MATISE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP06500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA RN111637) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2018-11-20 |