| NPI | 1609213669 |
|---|---|
| Former Name | JENNIFER ELAINE THREATT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI LP02915) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI LP02915) |
| 207W00000X Ophthalmology (Licence: NC 2017-00053) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2017-06-02 |