NPI | 1164855268 |
---|---|
Former Name | JENNIFER LANCE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00311500) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00311500) |
Enumeration Date | 2013-08-13 |
Last Update Date | 2021-12-06 |