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 |