| NPI | 1215540026 |
|---|---|
| Former Name | JENNA M. PROVANCE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2545) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2020-11-24 |