| NPI | 1639163249 |
|---|---|
| Former Name | JENNIFER LYNN GUSTAFSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9950) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9952) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2020-03-26 |