Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5013698 | NC |
NPI | 1215536784 |
---|---|
Provider Name | Jessica Small Jarvis |
First Address | Randleman, NC 27317-7238 |
Second Address | Durham, NC 27710-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2020 |
Last Update Date | 25/10/2020 |