| NPI | 1114029535 |
|---|---|
| Former Name | JENNIFER MARIE DE BLASE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 21721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001000396) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2011-09-20 |