| NPI | 1568036069 |
|---|---|
| Former Name | JORDAN REBECCA TYSINGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5014862) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 246720) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2022-07-08 |