| NPI | 1164772976 |
|---|---|
| Former Name | JENNIFER L SHIVELHOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 06610) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2024-01-29 |