Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 09837 | OH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 57200 | WV |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | WV57200 | WV |
NPI | 1003093790 |
---|---|
Provider Name | Ms. Jessica Eileen Stolz |
First Address | Marietta, OH 45750-1656 |
Second Address | Marietta, OH 45750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2008 |
Last Update Date | 24/11/2021 |