| NPI | 1972832558 |
|---|---|
| Former Name | JACQUELYN ROSE SORG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09638) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 013596) |
| 363AM0700X Physician Assistant Medical (Licence: PA MA054062) | |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2020-02-11 |