| NPI | 1861053639 |
|---|---|
| Former Name | JACLYN ROSE WUEBOLD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.025203) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2020-11-25 |