| NPI | 1548555899 |
|---|---|
| Former Name | JESSICA B TIEDEBOHL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA054908) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054908) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2022-08-26 |