NPI | 1568456044 |
---|---|
Former Name | JODEE MACDONALD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-322) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 322) |
Enumeration Date | 2005-09-09 |
Last Update Date | 2021-12-14 |