| NPI | 1790402535 |
|---|---|
| Former Name | JESSICA SHANNA STAKOFKSY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01392500) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01392500) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2024-05-07 |