| NPI | 1629532874 |
|---|---|
| Former Name | JENNIFER TRACY NOWACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 617489) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2020-04-01 |