Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 39002 | IA |
Y | 2080P0210X | Pediatric Nephrologist | 39002 | IA |
NPI | 1588985261 |
---|---|
Provider Name | Dr. Jennifer Garcia Jetton |
First Address | Iowa City, IA 52242-1007 |
Second Address | Iowa City, IA 52242-1007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 17/06/2010 |