| NPI | 1588102099 |
|---|---|
| Former Name | JACQUELINE FANNIE MEDINTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2016019103) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016019103) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2022-09-07 |