| NPI | 1073963328 |
|---|---|
| Former Name | JESSICA MARYANNE BLOOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 3674) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: TN 3674) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2022-10-10 |