| NPI | 1669727426 |
|---|---|
| Former Name | JENNIFER RUNYON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54363) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057314) |
| 363L00000X Nurse Practitioner (Licence: MD C0004793) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2018-02-06 |