| NPI | 1558098616 |
|---|---|
| Former Name | JACQUALIN ALEXIS LYDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063788) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA063788) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2024-11-14 |