| NPI | 1922168517 |
|---|---|
| Former Name | JAMIE MARIA MCCORMACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 69994) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VT 055-0031195) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 001000729) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NH 0670) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-05-27 |