| NPI | 1720793052 |
|---|---|
| Former Name | JENNIFER M BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209026802) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041393189) |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2023-10-11 |