| NPI | 1902178759 |
|---|---|
| Former Name | KAITLIN JENSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.004273) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004273) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2024-07-09 |