| NPI | 1720500747 |
|---|---|
| Former Name | JORDAN LEA BLAKEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 4056) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4056-23) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2019-04-17 |