| NPI | 1932583168 |
|---|---|
| Former Name | JADE T DEROCHER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4013) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R-198653-4) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN CNP4013) | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2020-08-10 |