| NPI | 1790922755 |
|---|---|
| Former Name | JENELLE CECILIA GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12053) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2020-11-13 |