| NPI | 1649938358 |
|---|---|
| Former Name | ALYSSA JOY IACOBONI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704299130NSA210D6) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2022-03-31 |