NPI | 1083251243 |
---|---|
Former Name | JORDAN CUNNINGHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0001361) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001361) |
Enumeration Date | 2019-12-06 |
Last Update Date | 2024-08-23 |