NPI | 1124447875 |
---|---|
Former Name | SARAH LYNNE ST. JEAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA 4935) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4935) |
Enumeration Date | 2014-04-09 |
Last Update Date | 2021-06-29 |