| NPI | 1699326553 |
|---|---|
| Former Name | JESSICA BALLARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61005912) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61005912) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2019-09-23 |