NPI | 1326532037 |
---|---|
Former Name | JANIKA PATRICIA SULLIVAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0979) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ND PAC0979) |
363AM0700X Physician Assistant, Medical (Licence: CA 55665) | |
363AS0400X Physician Assistant, Surgical (Licence: NV PA2149) | |
Enumeration Date | 2018-06-16 |
Last Update Date | 2023-12-27 |