NPI | 1740710441 |
---|---|
Former Name | MALLORY JONES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209016055) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.016055) |
Enumeration Date | 2017-06-14 |
Last Update Date | 2021-12-17 |