| NPI | 1770105694 |
|---|---|
| Former Name | JAYDE MONTGOMERY LIVELY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0027306) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027306) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-07-19 |