| NPI | 1790080653 |
|---|---|
| Former Name | JACEY A. BENNIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005554) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2021-12-23 |