| NPI | 1538241716 |
|---|---|
| Former Name | JENNIFER ANN GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051492) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA051492) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2021-01-07 |