| NPI | 1952661696 |
|---|---|
| Former Name | JESSICA RENEE GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 235439) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH APRN.CNP.025525) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: RI APRN02986) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ME CNP211365) | |
| Enumeration Date | 2012-05-28 |
| Last Update Date | 2023-02-01 |