| NPI | 1700351301 |
|---|---|
| Former Name | JESSICA LYNN VISTAIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 8937-33) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2019-10-21 |