| NPI | 1588124218 |
|---|---|
| Former Name | JENNIFER RENA BANNISTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 05533) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY R5155) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-07-24 |