NPI | 1558078709 |
---|---|
Former Name | JESSICA MARIE HUENECKE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 37542) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 37542) |
163WP0200X Registered Nurse, Pediatrics (Licence: TN 252633) | |
Enumeration Date | 2022-10-27 |
Last Update Date | 2025-09-07 |