| NPI | 1003210758 |
|---|---|
| Former Name | KELLY KATHLEEN O'DONOVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056994) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003347) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA056994) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2020-08-26 |