Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 13159 | CA |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 196088 | GA |
NPI | 1215083399 |
---|---|
Provider Name | Jennifer L Dwelle |
First Address | Powder Springs, GA 30127 |
Second Address | Atlanta, GA 30303-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 16/04/2008 |