| NPI | 1215649132 |
|---|---|
| Former Name | JESSICA LINDQUIST |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: LA 335429) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-1156) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2023-03-30 |