| NPI | 1689971079 |
|---|---|
| Former Name | JACQULINE LEE ECKERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 8003) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2019-12-16 |