| NPI | 1467984955 |
|---|---|
| Former Name | JESSICA NICOLE PHELPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: KY 59842) |
| Additional Taxonomies | 208800000X Urology (Licence: UT 12937203-1205) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2024-11-20 |