| NPI | 1548625668 |
|---|---|
| Former Name | JACCQUELYN LEE MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005203) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2020-06-01 |