NPI | 1699071571 |
---|---|
Former Name | JANAE VICKERS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21315) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA21315) |
Enumeration Date | 2011-02-09 |
Last Update Date | 2023-11-20 |