NPI | 1518338912 |
---|---|
Former Name | JESSICA L. HAYNE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2833) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057896) |
Enumeration Date | 2015-10-12 |
Last Update Date | 2022-02-10 |