| NPI | 1851870091 |
|---|---|
| Former Name | JENNIFER L WISTISEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 9875) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: ID PA-1660) | |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2025-07-01 |