| NPI | 1033415583 |
|---|---|
| Former Name | LYDIA ANNA VAN WINKLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2018-09-05 |