| NPI | 1972764165 |
|---|---|
| Former Name | JAMIE R MATHERLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 56344) |
| 207Q00000X Family Medicine (Licence: VA 0116018762) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2023-07-18 |