| NPI | 1073240925 |
|---|---|
| Former Name | AMANDA JACOBSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 62025) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: UT 13136356-1206) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2024-06-29 |