| NPI | 1659554921 |
|---|---|
| Former Name | JESSICA R ROACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3450-23) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 3450) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2025-09-02 |