| NPI | 1598027500 |
|---|---|
| Former Name | JESSICA ELAINE PRUSA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NE 30737) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IA 42413) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2020-04-07 |