| NPI | 1811420334 |
|---|---|
| Former Name | JACLYN MARIE PEICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT MED-PHYS-LIC-162037) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 30050) |
| 208000000X Pediatrics (Licence: MN 71262) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2026-01-23 |