NPI | 1336460922 |
---|---|
Former Name | JENNIFER ELIZABETH SAMPLES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 103860) |
Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL ME162888) |
208600000X Surgery (Licence: NC 2018-01719) | |
Enumeration Date | 2010-06-17 |
Last Update Date | 2025-05-14 |