| NPI | 1316229719 |
|---|---|
| Former Name | JESSICA RAE WELLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005340RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004105) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2018-01-11 |