| NPI | 1992992382 |
|---|---|
| Former Name | JESSICA WACKOWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004233) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053123) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2016-07-08 |