| NPI | 1902209844 |
|---|---|
| Former Name | JENNIFER LYNN HENDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9108310) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL PA9108310) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2018-06-04 |