| NPI | 1346064698 |
|---|---|
| Former Name | JORDAN NICOLE ROBERTSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2025-0008) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2025-06-04 |