| NPI | 1306404595 |
|---|---|
| Former Name | JACQUELYN ILENE DOLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: LA 312687) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 312687) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2024-01-12 |