| NPI | 1275765968 |
|---|---|
| Former Name | JENNIFER LACEY MARDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NC 0010-01986) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NC 0010-01986) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2020-10-25 |