NPI | 1336322866 |
---|---|
Former Name | JOLENE MARIE LUKASIEWICZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 672) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 111296) |
363AM0700X Physician Assistant, Medical (Licence: NE 672) | |
Enumeration Date | 2007-12-06 |
Last Update Date | 2025-06-09 |