| NPI | 1376629519 |
|---|---|
| Former Name | VANESSA JO SMOOK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0801) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1976) |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 1308) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2012-03-29 |