NPI | 1518693571 |
---|---|
Former Name | JENNIFER LYNNETTE MEACHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 13132) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI F07220418) |
Enumeration Date | 2022-08-01 |
Last Update Date | 2022-12-09 |