| NPI | 1851870091 |
|---|---|
| Former Name | JENNIFER L WISTISEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1660) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2022-06-12 |