| NPI | 1427683424 |
|---|---|
| Former Name | JENISSA DAWN GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: GA LD005226) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2023-12-07 |