NPI | 1871092601 |
---|---|
Former Name | JILLIAN A PHELPS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3017762) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KY 1141427) |
Enumeration Date | 2018-02-07 |
Last Update Date | 2022-06-14 |