| NPI | 1154445534 |
|---|---|
| Former Name | JACQUELYNN DANIELLE BERUMEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085004581) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 114211) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2013-03-12 |