| NPI | 1114333093 |
|---|---|
| Former Name | TRISHA MAE JEWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VT 055.0031399) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NH 1054) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2018-11-09 |