| NPI | 1619139995 |
|---|---|
| Former Name | JESSICA MARIE NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 7072) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10436) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2022-10-14 |