NPI | 1700495454 |
---|---|
Former Name | JESSICA ANN MAVENCAMP |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: MT NUR-APRN-LIC-160239) |
Enumeration Date | 2020-07-29 |
Last Update Date | 2024-01-30 |