NPI | 1922437342 |
---|---|
Former Name | JORDAN LYNNE SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 028207) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA056644) |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2013-11-06 |
Last Update Date | 2023-09-23 |