NPI | 1902391410 |
---|---|
Former Name | JENNA A LANDWEHR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 8713-33) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 223532-30) |
Enumeration Date | 2018-06-27 |
Last Update Date | 2020-03-27 |