| NPI | 1023249125 |
|---|---|
| Former Name | CAROLYN KYLE SIDLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA170105) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA170105) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2021-02-01 |