NPI | 1245424829 |
---|---|
Former Name | JENNA MARIE JONES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 003290) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002600) |
363A00000X Physician Assistant (Licence: OH 50.002600) | |
Enumeration Date | 2007-08-28 |
Last Update Date | 2017-09-01 |