| NPI | 1871084103 |
|---|---|
| Former Name | JENNIFER ODELL DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-02949) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2021-10-21 |