| 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 |