| NPI | 1346064698 |
|---|---|
| Former Name | JORDAN NICOLE ROBERTSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2024-11-13 |