| NPI | 1811546229 |
|---|---|
| Former Name | JENNIFER MARIE PONKOWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MI 5601009658) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009658) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2025-03-21 |