NPI | 1497199400 |
---|---|
Former Name | JESSICA NICOLE JACKSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2088F0040X Urology, Urogynecology and Reconstructive Pelvic Surgery (Licence: OH 35134272) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2013-04-20 |
Last Update Date | 2018-06-13 |