| NPI | 1699431346 |
|---|---|
| Former Name | JENNIFER MARIE RUSSOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 2021161664) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13140674091) |
| 163WG0000X Registered Nurse, General Practice (Licence: KS 13-140674091) | |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2021-11-18 |