| NPI | 1780965657 |
|---|---|
| Former Name | JESSICA E VANDERBOOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 4515-033) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 4515-033) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2017-09-07 |