Individual
JESSICA M SUPRISE
Active
Individual
JESSICA M SUPRISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1000-39
WI
363A00000X
Physician Assistant
4559
WI
363AS0400X
Surgical Physician Assistant
Primary
PA.0006023
CO
Other
Enumeration date
06/02/2014
Last updated
02/19/2020
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