NPI | 1023640034 |
---|---|
Former Name | FAITH KELLY DAMMANN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13331) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-02-07 |
Last Update Date | 2022-03-07 |