NPI | 1578078622 |
---|---|
Former Name | JENNIFER K GOODWIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12699) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-760) |
Enumeration Date | 2017-12-12 |
Last Update Date | 2024-06-28 |