NPI | 1013316280 |
---|---|
Former Name | JILLIAN ROSE STEGMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2756) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 2756) |
363A00000X Physician Assistant (Licence: IL 085.005178) | |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2014-08-13 |
Last Update Date | 2021-05-06 |