NPI | 1003587023 |
---|---|
Former Name | JENNA MARIE HALL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115035) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA115035) |
Enumeration Date | 2021-09-21 |
Last Update Date | 2021-09-27 |