| NPI | 1902495468 |
|---|---|
| Former Name | JENNIFER LEE MATYSKELA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 248734) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 11004-33) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2022-03-02 |