| NPI | 1952630279 |
|---|---|
| Former Name | JENNIFER LAUREN FONTAINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110004147) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013778) |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2013-06-07 |