NPI | 1962838516 |
---|---|
Former Name | JANA GAUNTT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA-2013-0065) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA-2013-0065) |
Enumeration Date | 2013-09-15 |
Last Update Date | 2023-11-16 |