NPI | 1083255830 |
---|---|
Former Name | JESSICA HEDRICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005854) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0005854) |
Enumeration Date | 2019-10-02 |
Last Update Date | 2024-09-16 |