| NPI | 1740867795 |
|---|---|
| Former Name | JENNIFER NICOLE RUTT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 94466) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2024-01477) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-08-05 |