| NPI | 1780105007 |
|---|---|
| Former Name | JENNIFER LYNN CLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017024399) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MO 2010006315) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2017-07-13 |