NPI | 1013265487 |
---|---|
Former Name | HEIDI JO LITTLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001003693) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03693) |
Enumeration Date | 2012-08-16 |
Last Update Date | 2017-06-27 |