Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | MA43137 | FL |
N | 225700000X | Massage Therapist | MA43137 | FL |
NPI | 1124512371 |
---|---|
Provider Name | Ms. Jennifer Lynn Wiersma |
First Address | Boynton Beach, FL 33435-8911 |
Second Address | Delray Beach, FL 33483-5209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 03/04/2020 |