| NPI | 1477832723 |
|---|---|
| Former Name | JENNILEE SUE MOE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10978) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 1589) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2021-03-11 |