| NPI | 1033608443 |
|---|---|
| Former Name | STEPHANIE WALK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9111229) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 9111229) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2019-05-13 |