| NPI | 1407120066 |
|---|---|
| Former Name | JESSICA LAURA BRENNAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OK PA2129) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-770) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2022-08-29 |