| NPI | 1972936250 |
|---|---|
| Former Name | JECIKA CHEVONNE-ESTELLE ELLISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 20153004) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 384514) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2016-04-02 |