| NPI | 1578837191 |
|---|---|
| Former Name | JENNA NICOLE LUCAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MI 5101027557) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102203568) |
| 208000000X Pediatrics (Licence: MI 5101027557) | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: VA 0102203568) | |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2023-10-20 |