| NPI | 1881002392 |
|---|---|
| Former Name | JEANNE PATRICE VANDENBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NV 0506269) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2020-02-20 |