| NPI | 1457456105 |
|---|---|
| Former Name | JENNIFER ANNE EIDAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085.003193) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 1000539) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-12-27 |