| NPI | 1861818791 |
|---|---|
| Former Name | JACQUEL DECEMBLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 410178) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 141677) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2019-08-27 |