| 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 |