NPI | 1003029224 |
---|---|
Former Name | ELLISSA A METTE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-002771) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA #052890) |
363A00000X Physician Assistant (Licence: WI 2370-023) | |
Enumeration Date | 2007-05-07 |
Last Update Date | 2009-11-24 |