| NPI | 1790104222 |
|---|---|
| Former Name | CASEY LEIGH JEWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA5057) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 2384) |
| 363A00000X Physician Assistant (Licence: SC 2384) | |
| Enumeration Date | 2014-04-11 |
| Last Update Date | 2019-10-16 |