| NPI | 1992447692 |
|---|---|
| Former Name | MARIAH LYNN JORDA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 82534) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2024-10-04 |