Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1083999502 |
---|---|
Provider Name | Mrs. Jessica Vail |
First Address | Derby, KS 67037-2442 |
Second Address | Derby, KS 67037-2442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2011 |
Last Update Date | 17/03/2018 |