| NPI | 1790192797 |
|---|---|
| Former Name | JENNIFER C. LANDIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 2515) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2515) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 2515) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2022-08-24 |