| NPI | 1689096331 |
|---|---|
| Former Name | JESSICA MANSOUR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704267272) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704267272) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2022-07-22 |