| NPI | 1730829318 |
|---|---|
| Former Name | MELISSA JORDAN FEDERICO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023043989) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-07-01 |