| NPI | 1750667648 |
|---|---|
| Former Name | JENNIFER LYNN AXLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2011003426) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 148289) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2023-07-31 |