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 |