| NPI | 1790347581 |
|---|---|
| Former Name | JAMIE LYNN RACCOSTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA7167) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-03-05 |