NPI | 1841547239 |
---|---|
Former Name | ABBE MICHELE JACKSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061783) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018655) |
363A00000X Physician Assistant (Licence: DE C5-0000831) | |
Enumeration Date | 2012-08-06 |
Last Update Date | 2022-06-07 |