Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2010004030 | MO |
NPI | 1023270170 |
---|---|
Provider Name | Jessica Winn |
First Address | Kansas City, MO 64184-3966 |
Second Address | Moberly, MO 65270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 01/09/2020 |