| NPI | 1477895282 |
|---|---|
| Former Name | JESSICA LYNN BUICKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX U5081) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME137796) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL B200-432-87-867-0) | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2023-10-03 |