NPI | 1821231333 |
---|---|
Former Name | JEANINE CATHERINE POPLAU |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005289) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 4342) |
363AM0700X Physician Assistant, Medical (Licence: WY PA889) | |
Enumeration Date | 2009-04-14 |
Last Update Date | 2021-01-06 |