NPI | 1679978753 |
---|---|
Former Name | JESSICA LYNN SAND |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12257) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 5865) |
Enumeration Date | 2014-10-30 |
Last Update Date | 2020-08-27 |