NPI | 1780839449 |
---|---|
Former Name | KRISTINA ANNE JADLOCKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105227) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105227) |
363AM0700X Physician Assistant, Medical (Licence: WA PA060056738) | |
Enumeration Date | 2008-11-22 |
Last Update Date | 2021-04-28 |