| NPI | 1376971101 |
|---|---|
| Former Name | REBEKAH CHRISTINE GANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00603100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003134) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA056126) | |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2022-04-14 |