NPI | 1619017167 |
---|---|
Former Name | JENNIFER LYNN MILLMUN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004370) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004370) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2022-07-22 |