| NPI | 1912312935 |
|---|---|
| Former Name | JESSICA LAUREN NOWAK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY SN006847-01) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA sc006577) |
| Enumeration Date | 2014-06-28 |
| Last Update Date | 2021-04-06 |