| NPI | 1700880515 |
|---|---|
| Former Name | JENNIFER DAWN DIBRELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04343) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX 1066468) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2014-10-21 |