| NPI | 1801101464 |
|---|---|
| Former Name | JENNIFER NICOLE BLADES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO 50314) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-08-07 |
| Last Update Date | 2016-04-04 |