NPI | 1316226384 |
---|---|
Former Name | JAN MICHELLE KEHRES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.003658) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA055065) |
363AM0700X Physician Assistant, Medical (Licence: PA MA055065) | |
363AM0700X Physician Assistant, Medical (Licence: OH 50.003658) | |
Enumeration Date | 2011-08-09 |
Last Update Date | 2016-07-08 |