NPI | 1093160640 |
---|---|
Former Name | JOLYNN REED |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 5903) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.005890) |
Enumeration Date | 2016-05-02 |
Last Update Date | 2022-12-27 |