| NPI | 1467095869 |
|---|---|
| Former Name | JESSICA MICHELLE BRADDOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MS 905426) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R874853) |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2022-10-14 |