Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5014259 | NC |
NPI | 1295314102 |
---|---|
Provider Name | Mrs. Jennifer Reach |
First Address | Lena, MS 39094-9318 |
Second Address | Fayetteville, NC 28304-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2021 |
Last Update Date | 07/04/2021 |