| NPI | 1952825663 |
|---|---|
| Former Name | JESSICA SHIPLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: CT 1992372403) |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty (Licence: NY 1043889967) |
| 261QM2500X Clinic/Center Medical Specialty (Licence: NJ 1992372403) | |
| 363LF0000X Nurse Practitioner Family (Licence: PA F06171944) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2024-10-03 |