| NPI | 1598813974 |
|---|---|
| Former Name | JEANNA MARIE CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3017142) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A078000) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2023-12-11 |