NPI | 1265985626 |
---|---|
Former Name | JENNIFER DONNELLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11037) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM PA2017-0003) |
363AM0700X Physician Assistant, Medical (Licence: NM PA2017-0003) | |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2016-08-02 |
Last Update Date | 2024-01-05 |