| NPI | 1568763019 |
|---|---|
| Former Name | JACKIE DEE STAFFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS 813602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 111885) |
| Enumeration Date | 2010-11-14 |
| Last Update Date | 2024-01-09 |